A pulmonary embolism, or PE, is a potentially life-threatening medical condition. Here’s what you need to know about this lung condition, including what it is and its risk factors, types, symptoms and treatments.
What is a pulmonary embolism?
A pulmonary embolism, or PE, is caused by blood clots in the major arteries in the lungs. The blood clots typically form as a clot in the veins of the legs (deep vein thrombosis, or DVT), travel through the heart and get stuck in the lungs. They are responsible for up to 300,000 deaths per year and are one of the leading causes of cardiovascular mortality in the United States.
Risk factors for pulmonary embolism
There are many risk factors for developing pulmonary embolisms. However, it is important to note that many patients with pulmonary embolism have no risk factors at all.
Some of the most common risk factors may include:
Family history: We can test for some genes and mutations that may put you at a higher risk but there are probably many more genetic factors that make people more likely to have a pulmonary embolism if they have a family member with a history of DVT or PE.
Medical conditions, such as cancer, kidney disease, liver disease, heart disease or heart failure, inflammatory bowel disease, autoimmune diseases or COVID-19 infection
Medications, such as birth control, hormone replacement therapy, testosterone, certain antidepressants, steroids and tamoxifen
Recent surgery or trauma
Periods of immobilization, such as very long travel times or a very sedentary lifestyle
Obesity
Pregnancy
Types of pulmonary embolism
Pulmonary emboli are classified based on their severity and how long they have been in the lungs.
Acute: This is when patients come to the hospital at the time or shortly after a blood clot travels to the lungs (hours to days).
Sub-acute: This is when patients present days to weeks after the clot forms. This usually happens when patients wait a little while to see if symptoms get better before coming into the hospital. In some cases, symptoms may also be more gradual in onset.
Chronic thromboembolic pulmonary hypertension (CTEPH): CTEPH is a condition where blood clots accumulate and block the lung arteries over time. This leads to high blood pressure in the lungs (pulmonary hypertension) and potentially heart failure.
Low/intermediate/high risk: This is an additional classification that doctors make to help determine how dangerous the pulmonary embolism is. This can help guide further testing, monitoring and treatment decisions.
Your doctor will classify your PE based on your symptoms and other clinical information like vital signs, lab work and imaging of your heart.
Pulmonary embolism symptoms
Symptoms of pulmonary embolism are caused by blood clots in the legs becoming dislodged, traveling through the heart and getting stuck in the arteries in the lungs. This can interfere with the body’s ability to get oxygen from the lungs into the blood and, in some cases, can also make the heart sick.
Common pulmonary embolism symptoms may include:
Shortness of breath or trouble breathing while relaxing, walking and/or laying flat
Chest pain with or without deep breaths
Cough
Leg pain with or without leg swelling
Wheezing
Coughing up blood
Suddenly losing consciousness
Pulmonary embolism treatment
Depending on your type of pulmonary embolism, you may receive different treatments. This depends on the acuity and severity of your pulmonary embolism.
Blood thinners or anticoagulants: These may include pills like Eliquis, Xarelto or Warfarin/Coumadin, injections like Lovenox, or continuous infusions like heparin if you are in the hospital.
Clot busters or thrombolytics: These are rapid-acting blood thinners that instantly dissolve clots. This is reserved for life-threatening pulmonary embolisms, and your doctor will determine if it is appropriate for you.
Invasive procedures/surgery:
Catheter-directed thrombolysis and/or thrombectomy: A specialized interventional physician will guide a long catheter into your lungs under live X-ray. Here, they will either directly inject a clot buster into the clot, or they will manually “suction” the clot out through a special catheter. Sometimes, the catheter will stay in for a day or two to allow doctors to give more clot-busting medication and dissolve more of the clot.
Inferior vena cava (IVC) filter: This is when a filter is placed into the large vein between your legs and your heart. This is placed in patients who cannot have blood thinners due to other medical problems. The filter acts as a “net” filter to catch any blood clots before they reach the lung.
Surgical thromboendoarterectomy: This is open-heart surgery to physically remove the clot. This is reserved as a last resort and requires an experienced cardiothoracic surgeon.
Balloon pulmonary angioplasty: This opens up the lungs with catheters and balloons. This is done by an experienced interventional cardiologist and requires multiple treatments.
Living with pulmonary embolism
At Montefiore Health System, we’ve found that patients diagnosed with pulmonary embolism are likely to still be able to live a relatively normal life, just with some precautions.
You will most likely be on a blood thinner, either for several months or potentially for the rest of your life. While you are on a blood thinner, you must take precautions to avoid injuries, especially head injuries, and call your doctor if you notice any signs of bleeding, such as nose bleeds that don’t stop, coughing up blood, black or red stools, or any signs of stroke.
You should also talk to your doctor about lifestyle changes to manage your risk factors (for example, weight management, healthy dieting or quitting smoking). It is important to stay up to date with recommended screening for cancers (colonoscopy, mammograms, etc.) based on your age and risk factors, too.
Your doctor will also talk with you to see if any medication changes are necessary for your health problems.
